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Atrial Fibrillation Innovation Program: Transitioning Emergency Atrial Fibrillation Management (Team) - Lessons From A Feasibility Trial
Abstracts
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single-shot acquisition T1 mapping sequence. Subjects also performed peak aerobic capacity (VO2) testing, a vertical jump test, and a wall squat test. RESULTS: Compared to controls, cancer survivors had significantly lower LVEF (57.5 6.2% vs. 64.3 5.5%, P<0.001), LV indexed mass (48.9 13.7 g/m2 vs. 62.7 10.2 g/m2, P<0.001), LV mass/volume ratio (0.67 0.17 vs. 0.89 0.17, P<0.001), and peak VO2 (28.1 4.9 mL/kg/ min vs. 33.8 4.9 mL/kg/min, P<0.01). Between survivors and controls, there was no difference in myocardial ECVF (19.8 1.9% vs. 19.8 2.3%, P¼0.95), thigh ECVF (5.6 0.9% vs. 5.9 1.1%, P¼0.25), vertical jump distance (35.2 10.1 cm vs. 40.4 11.6 cm, P¼0.10), or wall squat duration (91 53 s vs. 111 58 s, P¼0.24). Myocardial ECVF and thigh ECVF were unrelated to cumulative anthracycline dose (r¼-0.10, P¼0.54, and r¼-0.11, P¼0.52, respectively). CONCLUSION: Asymptomatic childhood cancer survivors have significantly lower LVEF, LV mass, and LV mass/volume ratio, compared to controls, suggesting that conventional MRI is sensitive to early changes associated with anthracycline cardiotoxicity. Myocardial and thigh ECVF were similar between survivors and controls, suggesting that fibrosis is not a major component of these gross structural and functional changes. Long-term serial follow-up of a larger group of cancer survivors could provide further insight into the role of MRI in assessment of anthracyline cardiotoxicity in individual subjects. ACHRI Canadian Cardiovascular Society (CCS) Poster ATRIAL FIBRILLATION CLINICAL Thursday, October 17, 2013 030 ATRIAL FIBRILLATION INNOVATION PROGRAM: TRANSITIONING EMERGENCY ATRIAL FIBRILLATION MANAGEMENT (TEAM) LESSONS FROM A FEASIBILITY TRIAL N Meshkat, K Leblanc, S Bhatia, P Dorian, N Ivers, A Valentinis, L Ashley, AC Ha, K Benson, D Morra Toronto, Ontario BACKGROUND: Atrial fibrillation (AF) is a common cardiac arrhythmia, and its incidence is growing as the population ages. AF is responsible for an increasing number of emergency department (ED) visits. The fragmentation of care of this chronic condition is a driver for avoidable health utilization and costs. We hypothesized that a transition of care intervention targeted at ED patients with primary AF would reduce avoidable hospitalizations. METHODS: We conducted a prospective feasibility study at two academic emergency departments targeting patients with primary AF. CCS guideline-based acute AF management pathways, patient education materials, and discharge of patients from the ED supported by early follow up were instituted. At
the center of the follow up care is the Atrial Fibrillation Quality Care Program (AF-QCP), a nurse practitioner and pharmacistcentered initiative supported by an interdisciplinary team of internists, and cardiologists. The AF-QCP engages in a shared care model to coordinate the care of AF patients with an overarching principle of reintegrating the patient's care back to the primary care setting. A shared AF Care Plan, support for the primary care providers and patient in the form of a 1-800 number for timely access to clinical advice, and tailored patient education geared toward patient self management was provided. RESULTS: During an 8-month period, 279 patients with primary AF presented to the two academic EDs. The baseline admission rates from 2010 were 38% and decreased to 31.2% after implementing the intervention (p ¼ 0.06). Of the admitted patients (n¼87), 19 (21.8%) were admitted for less than 24 hours. Of discharged ED patients, 41 (21.4%) were seen at the AF-QCP. Three ED visits were avoided by calling the support line. DISCUSSION: Preliminary results of this guideline-based, interdisciplinary shared care intervention suggest a decrease in hospitalizations. There is opportunity to further reduce healthcare utilization via this intervention by targeting patients admitted for less than 24 hours, and increasing referrals to the AF-QCP. Further study is required to fully assess the impact on patient outcomes. Ministry of Health and Long Term Care BRIDGES Program
031 CHARACTERISTICS OF PATIENTS WITH ATRIAL FIBRILLATION USING DABIGATRAN VS. WARFARIN-EVIDENCE FROM A POPULATION BASED COHORT M Avgil Tsadok, CA Jackevicius, V Essebag, MJ Eisenberg, E Rahme, L Pilote Montréal, Québec BACKGROUND: Dabigatran is an oral direct thrombin inhibitor, recently approved for stroke prevention in patients with atrial fibrillation (AF) as an alternative to warfarin, which became available in Québec in April 2011. We aimed to characterize the population of AF patients who filled a prescription for dabigatran (110 mg and 150 mg BID) and compare it to those patients filling warfarin prescriptions in the real world setting. METHODS: We conducted a population-based study using administrative data of patients with AF, with linkages between hospital discharge databases and prescription drug claims in Québec. We identified patients who had a filled prescription for dabigatran and compared their demographic and clinical characteristics to those who filled warfarin prescriptions, matched on date of first dabigatran prescription and date of index AF hospitalization. RESULTS: The cohort consisted of 10,657 patients treated with dabigatran and 49,202 patients treated with warfarin. Dabigatran users were slightly younger than warfarin users (77.1 vs. 78.5 years, p<0.001), had a higher proportion of male patients and patients in the rural setting. Generally, burden of
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single-shot acquisition T1 mapping sequence. Subjects also performed peak aerobic capacity (VO2) testing, a vertical jump test, and a wall squat test. RESULTS: Compared to controls, cancer survivors had significantly lower LVEF (57.5 6.2% vs. 64.3 5.5%, P<0.001), LV indexed mass (48.9 13.7 g/m2 vs. 62.7 10.2 g/m2, P<0.001), LV mass/volume ratio (0.67 0.17 vs. 0.89 0.17, P<0.001), and peak VO2 (28.1 4.9 mL/kg/ min vs. 33.8 4.9 mL/kg/min, P<0.01). Between survivors and controls, there was no difference in myocardial ECVF (19.8 1.9% vs. 19.8 2.3%, P¼0.95), thigh ECVF (5.6 0.9% vs. 5.9 1.1%, P¼0.25), vertical jump distance (35.2 10.1 cm vs. 40.4 11.6 cm, P¼0.10), or wall squat duration (91 53 s vs. 111 58 s, P¼0.24). Myocardial ECVF and thigh ECVF were unrelated to cumulative anthracycline dose (r¼-0.10, P¼0.54, and r¼-0.11, P¼0.52, respectively). CONCLUSION: Asymptomatic childhood cancer survivors have significantly lower LVEF, LV mass, and LV mass/volume ratio, compared to controls, suggesting that conventional MRI is sensitive to early changes associated with anthracycline cardiotoxicity. Myocardial and thigh ECVF were similar between survivors and controls, suggesting that fibrosis is not a major component of these gross structural and functional changes. Long-term serial follow-up of a larger group of cancer survivors could provide further insight into the role of MRI in assessment of anthracyline cardiotoxicity in individual subjects. ACHRI Canadian Cardiovascular Society (CCS) Poster ATRIAL FIBRILLATION CLINICAL Thursday, October 17, 2013 030 ATRIAL FIBRILLATION INNOVATION PROGRAM: TRANSITIONING EMERGENCY ATRIAL FIBRILLATION MANAGEMENT (TEAM) LESSONS FROM A FEASIBILITY TRIAL N Meshkat, K Leblanc, S Bhatia, P Dorian, N Ivers, A Valentinis, L Ashley, AC Ha, K Benson, D Morra Toronto, Ontario BACKGROUND: Atrial fibrillation (AF) is a common cardiac arrhythmia, and its incidence is growing as the population ages. AF is responsible for an increasing number of emergency department (ED) visits. The fragmentation of care of this chronic condition is a driver for avoidable health utilization and costs. We hypothesized that a transition of care intervention targeted at ED patients with primary AF would reduce avoidable hospitalizations. METHODS: We conducted a prospective feasibility study at two academic emergency departments targeting patients with primary AF. CCS guideline-based acute AF management pathways, patient education materials, and discharge of patients from the ED supported by early follow up were instituted. At
the center of the follow up care is the Atrial Fibrillation Quality Care Program (AF-QCP), a nurse practitioner and pharmacistcentered initiative supported by an interdisciplinary team of internists, and cardiologists. The AF-QCP engages in a shared care model to coordinate the care of AF patients with an overarching principle of reintegrating the patient's care back to the primary care setting. A shared AF Care Plan, support for the primary care providers and patient in the form of a 1-800 number for timely access to clinical advice, and tailored patient education geared toward patient self management was provided. RESULTS: During an 8-month period, 279 patients with primary AF presented to the two academic EDs. The baseline admission rates from 2010 were 38% and decreased to 31.2% after implementing the intervention (p ¼ 0.06). Of the admitted patients (n¼87), 19 (21.8%) were admitted for less than 24 hours. Of discharged ED patients, 41 (21.4%) were seen at the AF-QCP. Three ED visits were avoided by calling the support line. DISCUSSION: Preliminary results of this guideline-based, interdisciplinary shared care intervention suggest a decrease in hospitalizations. There is opportunity to further reduce healthcare utilization via this intervention by targeting patients admitted for less than 24 hours, and increasing referrals to the AF-QCP. Further study is required to fully assess the impact on patient outcomes. Ministry of Health and Long Term Care BRIDGES Program
031 CHARACTERISTICS OF PATIENTS WITH ATRIAL FIBRILLATION USING DABIGATRAN VS. WARFARIN-EVIDENCE FROM A POPULATION BASED COHORT M Avgil Tsadok, CA Jackevicius, V Essebag, MJ Eisenberg, E Rahme, L Pilote Montréal, Québec BACKGROUND: Dabigatran is an oral direct thrombin inhibitor, recently approved for stroke prevention in patients with atrial fibrillation (AF) as an alternative to warfarin, which became available in Québec in April 2011. We aimed to characterize the population of AF patients who filled a prescription for dabigatran (110 mg and 150 mg BID) and compare it to those patients filling warfarin prescriptions in the real world setting. METHODS: We conducted a population-based study using administrative data of patients with AF, with linkages between hospital discharge databases and prescription drug claims in Québec. We identified patients who had a filled prescription for dabigatran and compared their demographic and clinical characteristics to those who filled warfarin prescriptions, matched on date of first dabigatran prescription and date of index AF hospitalization. RESULTS: The cohort consisted of 10,657 patients treated with dabigatran and 49,202 patients treated with warfarin. Dabigatran users were slightly younger than warfarin users (77.1 vs. 78.5 years, p<0.001), had a higher proportion of male patients and patients in the rural setting. Generally, burden of